Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jul 6, 2019; 7(13): 1717-1725
Published online Jul 6, 2019. doi: 10.12998/wjcc.v7.i13.1717
Liver failure associated with benzbromarone: A case report and review of the literature
Ming-Yuan Zhang, Jun-Qi Niu, Xiao-Yu Wen, Qing-Long Jin
Ming-Yuan Zhang, Jun-Qi Niu, Xiao-Yu Wen, Qing-Long Jin, Department of Hepatology, First Hospital of Jilin University, Changchun 130021, Jilin Province, China
Author contributions: Zhang MY was the patient’s attending physician, and she contributed to the manuscript drafting and reviewed the literature; Niu JQ was responsible for the revision of the manuscript; Wen XY collected the patient’s clinical data and contributed to the manuscript drafting; Jin QL designed the report and revised the manuscript; Wen XY and Jin QL are co-corresponding authors; all authors issued final approval for the version to be submitted.
Informed consent statement: The study was reviewed and approved by the First Hospital of Jilin University Institutional Review Board. The patient and his family were offered written explanations prior to the start of treatment, and they provided consent.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest, and no additional data are available.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised accordingly.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Qing-Long Jin, MD, PhD, Professor, Department of Hepatology, First Hospital of Jilin University, No. 71, Xinmin Street, Changchun 130021, Jilin Province, China. jinql@jlu.edu.cn
Telephone: +86-138-4410 9523Fax: +86-431-88786006
Received: March 15, 2019
Peer-review started: March 15, 2019
First decision: April 18, 2019
Revised: April 22, 2019
Accepted: May 2, 2019
Article in press: March 2, 2019
Published online: July 6, 2019
Processing time: 113 Days and 20.7 Hours
Abstract
BACKGROUND

Benzbromarone is a uricosuric agent that reduces proximal tubular reabsorption of uric acid. Because of hepatotoxicity, it has been withdrawn from the market in Europe. Recently, some benefit-risk assessments of benzbromarone suggest that benzbromarone has greater benefits than risks, and the application of benzbromarone in the treatment of gout and hyperuricemia is still under debate.

CASE SUMMARY

A 39-year-old man was admitted to the hospital for icterus and nausea, and he was treated with benzbromarone (100 mg/d) for 4 mo because of hyperuricemia. He had a 10-year history of beer drinking (alcohol: about 28 g/d). Laboratory data showed severe liver injury and serious coagulation dysfunction; tests for autoimmune antibodies, viral hepatitis, and human immunodeficiency virus were negative. Despite administration of liver function-protecting drugs and efficient supportive treatment, the patient deteriorated quickly after hospitalization and developed grade II encephalopathy within a few days. The patient accepted continuous plasma exchange six times; however, his condition did not improve. Based on suggestions from multidisciplinary consultation, the patient underwent liver transplantation 26 d after admission. Liver specimen pathology results showed massive necrosis consistent with drug-induced liver injury, supporting the diagnosis of acute liver failure associated with benzbromarone. The patient recovered quickly thereafter.

CONCLUSION

This case highlights that clinicians should be on the alert for the severe hepatotoxicity of benzbromarone. Before prescribing benzbromarone, physicians should evaluate the high-risk factors that may lead to liver injury and provide suggestions for monitoring benzbromarone's hepatotoxicity during treatment.

Keywords: Benzbromarone; Hepatotoxicity; Liver failure; Liver transplantation; Case report

Core tip: Here, we present a case of liver failure associated with benzbromarone. This is the ninth reported case associated with benzbromarone hepatotoxicity to date. We recommend that before prescribing, the benefits and risks of benzbromarone should be carefully evaluated. Additionally, an in-depth understanding of the relevant high-risk factors that may lead to liver injury and the prompt monitoring of hepatotoxicity of benzbromarone are essential.